Clinical Hours Research Articles

Primary Care Physician Preferences Regarding Communication from Orthopaedic Surgeons.

Musculoskeletal consultations constitute a growing portion of primary care physician (PCP) referrals. Optimizing communication between PCPs and orthopaedists can potentially reduce time spent in the electronic medical record (EMR) as well as physician burnout. Little is known about the preferences of PCPs regarding communication from orthopaedic surgeons. Hence, the present study investigated, across a large health network, the preferences of PCPs regarding communication from orthopaedists. A total of 175 PCPs across 15 practices within our health network were surveyed. These providers universally utilized Epic as their EMR platform. Five-point, labeled Likert scales were utilized to assess the PCP-perceived importance of communication from orthopaedists in specific clinical scenarios. PCPs were further asked to report their preferred method of communication in each scenario and their overall interest in communication from orthopaedists. Logistic regression analyses were performed to determine whether any PCP characteristics were associated with the preferred method of communication and the overall PCP interest in communication from orthopaedists. A total of 107 PCPs (61.1%) responded to the survey. PCPs most commonly rated communication from orthopaedists as highly important in the scenario of an orthopaedist needing information from the PCP. In this scenario, PCPs preferred to receive an Epic Staff Message. Scenarios involving a recommendation for surgery, hospitalization, or a major clinical change were also rated as highly important. In these scenarios, an Epic CC'd Chart rather than a Staff Message was preferred. Increased after-hours EMR use was associated with diminished odds of having a high interest in communication from orthopaedists (odds ratio, 0.65; 95% confidence interval, 0.48 to 0.88; p = 0.005). Ninety-three PCPs (86.9%) reported spending 1 to 1.5 hours or more per day in Epic after normal clinical hours, and 27 (25.2%) spent >3 hours per day. Forty-six PCPs (43.0%) reported experiencing ≥1 symptom of burnout. There were distinct preferences among PCPs regarding clinical communication from orthopaedic surgeons. There was also evidence of substantial burnout and after-hours work effort by PCPs. These results may help to optimize communication between PCPs and orthopaedists while reducing the amount of time that PCPs spend in the EMR.

"How are you?" Perspectives From Patients and Health Care Providers of Text Messaging to Support Rheumatoid Arthritis Care: A Thematic Analysis.

Patients with rheumatoid arthritis (RA) may need to access rheumatology care between scheduled visits. WelTel is a virtual care platform that supports secure two-way text-messaging between patients and their health care team. The objective of the present study was to explore perspectives and experiences of health care providers (HCPs) and patients related to the use of WelTel as an adjunct to routine care. Seventy patients with RA were enrolled in a six-month WelTel pilot project launched in September 2021. Patients received monthly "How are you?" text message check-ins and could message their health care team during clinic hours to request health advice. The current project is a qualitative study of the WelTel pilot. A subgroup of pilot participants was purposively sampled and invited to participate in interviews. A thematic analysis of transcripts was conducted using a deductive approach leveraging quality of care domains. Thirteen patients (62% female, mean age 62 years, 10 White) completed interviews. Patients' views suggested that text messaging with the rheumatology team supported high-quality care across multiple quality domains including patient-centeredness, timeliness, efficiency, safety, effectiveness, equity, and appropriateness. Seven HCPs (57.1% female, one pharmacist and six rheumatologists) completed interviews. HCPs' perspectives varied based on their experience with the WelTel platform. Additional themes reported by HCPs included perceived increased workload and burnout. Patients with RA perceived text-based messaging as supporting high-quality care. The impact of increased communications on HCP burnout and workload requires consideration, and future studies should evaluate the effect of texting on patient outcomes.

Factors Influencing Music Therapists' Retention of Clinical Hours with Autistic Clients over Telehealth During the COVID-19 Pandemic.

The 2019 coronavirus disease pandemic influenced music therapists to migrate services to online platforms, though some lost clinical hours during the pandemic when telehealth was not a viable option. This survey study aimed to ascertain factors that helped music-based therapists to continue serving autistic clients over telehealth during the pandemic. We surveyed 193 accredited music therapists located mainly in Canada and the US. In addition to gathering data on general perceptions of telehealth music therapy and Neurologic Music Therapy (NMT), one-way ANOVAs were applied to determine differences in percent-change loss of clinical hours for music therapists: (1) working in different employment settings; (2) serving children, youth, adults, or a mixture of ages; and (3) practicing NMT or not. The general perception of telehealth music therapy was positive, and NMTs believed that the clear protocols and transformation design model were helpful to them in adapting services to telehealth. There were no significant differences in percent-change of clinical hours among music therapists in different employment settings or serving different client age groups. Music therapists who said they practiced within the NMT treatment model lost a significantly lower percentage of clinical hours with autistic clients than those who did not practice NMT. Possible reasons for this result and the need for further research are discussed.

Clinical Full-Time Equivalent in PICUs: Survey of the U.S. Pediatric Critical Care Chiefs Network, 2020-2022.

To inform workforce planning for pediatric critical care (PCC) physicians, it is important to understand current staffing models and the spectrum of clinical responsibilities of physicians. Our objective was to describe the expected workload associated with a clinical full-time equivalent (cFTE) in PICUs across the U.S. Pediatric Critical Care Chiefs Network (PC3N). Cross-sectional survey. PICUs participating in the PC3N. PICU division chiefs or designees participating in the PC3N from 2020 to 2022. None. A series of three surveys were used to capture unit characteristics and clinical responsibilities for an estimated 1.0 cFTE intensivist. Out of a total of 156 PICUs in the PC3N, the response rate was 46 (30%) to all three distributed surveys. Respondents used one of four models to describe the construction of a cFTE-total clinical hours, total clinical shifts, total weeks of service, or % full-time equivalent. Results were stratified by unit size. The model used for construction of a cFTE did not vary significantly by the total number of faculty nor the total number of beds. The median (interquartile range) of clinical responsibilities annually for a 1.0 cFTE were: total clinical hours 1750 (1483-1858), total clinical shifts 142 (129-177); total weeks of service 13.0 (11.3-16.0); and total night shifts 52 (36-60). When stratified by unit size, larger units had fewer nights or overnight hours, but covered more beds per shift. This survey of the PC3N (2020-2022) provides the most contemporary description of clinical responsibilities associated with a cFTE physician in PCC. A 1.0 cFTE varies depending on unit size. There is no correlation between the model used to construct a cFTE and the associated clinical responsibilities.

Factors Associated With Sleep Quality Among Undergraduate Nursing Students During Clinical Practicums.

Limited evidence exists on factors influencing nursing students' sleep quality during clinical practicums. This study examined the sleep quality of nursing students and factors that affect sleep quality during clinical practicums. Undergraduate nursing students (n = 135) enrolled in clinical practicums in 3 universities completed questionnaires including sociodemographics and the Pittsburgh Sleep Quality Index (PSQI). Stepwise linear regression evaluated factors predicating sleep quality. Seventy percent of nursing students reported poor sleep quality. Weekly work hours and clinical hours were significant factors in predicting global PSQI scores, subjective sleep quality, sleep duration, sleep efficiency, and daytime dysfunctions. The students' race was related to sleep latency and sleeping medication. Clinical hours and living on campus were associated with sleep disturbances. Knowing the factors that influence nursing students' sleep during clinical practicums, nurse educators can help students improve sleep health and clinical experience.

Increasing HIV Screening in a Federally Qualified Health Center: A Quality Improvement Project.

Background: HIV is a chronic infection that can lead to acquired immunodeficiency syndrome, a life-threatening condition. The highest number of new HIV diagnoses occurs in males, particularly Black men living in the southern region of the United States. Black men tend to test less frequently than other races. Objective: This pilot project was a quality improvement (QI) initiative to increase HIV screening rates among Black men who received healthcare at a Federally Qualified Healthcare Center (FQHC). Methods: The 8-week QI initiative was implemented during clinic hours. A retrospective chart review was performed to compare baseline with post-initiative HIV screening rates for eligible patients who received care in Birmingham, Alabama, which was shown to be low. Then, a risk assessment questionnaire was administered before providing educational materials to improve screening rates among Black men at an urban multisite FQHC. Results: HIV screening rates among Black men increased after the two-part initiative (20% and 21%, respectively). Conclusions: This QI initiative demonstrated that HIV screening rates could increase with tailored provider-initiated interventions, including risk assessment and educational materials. Implications for Nursing: A DNP or other healthcare providers could use this project to inform the development of a larger-scale QI initiative at an FQHC to improve HIV screening rates for under-resourced populations.

WHAT HAPPENED TO ORTHOPAEDIC RESIDENCY AND RESEARCH DURING THE PANDEMIC?

In March 2020, COVID-19 was declared a pandemic by the World Health Organization. The pandemic imposed drastic changes in our social and professional routine. Professionally at all levels our hospital tasks were changed and prioritized. Surgeons and residents were deployed on rotations to fields other than their expertise in orthopaedics. Health-care education received major changes in these challenging times, and students did face difficulties in receiving education, as well as training due to limited clinical and surgical exposure.In response to the WHO regulations, most of the teaching centres and hospitals worldwide have adopted the web-based teaching and learning model to continue the education and training of orthopaedic residents. These results brought significant changes to the training experience in orthopaedic surgery in combination with the fact that clinical duty hours and case volume were substantially reduced.In what concerns orthopaedic journal publications, the Covid-19 pandemic resulted in a decline in the annual publication rate for the first time in over 20 years. Although not uniform, the reduction was most likely due to multifactorial causes.Regarding the appraisal at the end of training, at the Orthopaedic European Board Examination we were able to verify that the outcome at the written part 1 exam was good, equivalent to the outcome prior to the pandemic. However the oral viva was much worse, probably due to the fact that residents skipped much of the clinical and surgical teaching and exposure during 2020 and 2021. At the end of training, theoretical/factual knowledge was good but poor from the clinical practical experience.

Career transition plans of veterinarians in clinical practice.

Gain an understanding of the career transition plans of veterinarians in clinical practice. Veterinary members of the Veterinary Information Network (VIN) working as small animal clinicians. An electronic survey distributed via the VIN data collection portal. A total of 1,256 responses from veterinarians in clinical practice were analyzed, with 61% indicating they plan to decrease their clinical work, and 31% to stop entirely within the next 5 years. The most common reasons for these choices were to have more free time for oneself and/or family/friends (76%), to maintain good health (59%), and feeling burned out (50%). Factors that might entice them to retain their current number of clinical hours included reduced workload or shorter hours (42%), financial incentivization (38%), and improved working conditions (26%). Concerns related to retirement were common with 47% of participants in our study reported feeling concerned about the loss of professional identity, 34% reported concern about reduced social connections, and 28% reported concern as to how they would fill their time. The reported desire to reduce/stop one's clinical work within the next 5 years by 42% of veterinarians ≤44 years of age, with burnout a primary predictor, offers insights into the necessity of change at the organizational, systemic (versus individual) level. The fact that many participants reported concerns related to retirement and 32% reported that they did not have adequate retirement information suggests a need for supportive services to help ensure a successful transition.

Effectiveness of "Rule of Seven" intervention in improving control status in diabetes mellitus protocol of a randomized controlled trial.

We developed the "rule of seven" intervention because different targets related to diabetes control can somehow be calculated by multiplication of seven. This study aimed to evaluate the effectiveness of the "rule of seven" in improving glycemic control in patients diagnosed with diabetes by measuring fasting plasma glucose and 2 hours postprandial plasma glucose. This two-arm randomized controlled trial will compare the effectiveness of the "rule of seven" intervention in achieving glycemic control in diabetes mellitus patients. The patients in the control arm will receive routine patient counseling related to diabetes mellitus. Patients registered with the noncommunicable disease (NCD) clinics of All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Community Health Center (CHC) Tangi, and CHC Mendhasala will be recruited consecutively during clinic hours after fulfilling eligibility criteria and obtaining written informed consent. The sample size was estimated as 426 in each group. The ethical permission was obtained from the Institutional Ethics Committee (IEC) and prospectively registered in the Clinical Trial Registry of India (CTRI/2023/07/055522). After the intervention, we will find out the change in knowledge regarding parameters related to glycemic status; discover the change in biochemical parameters after 1, 3, and 6 months; and conclude whether those changes are statistically significant or not.

Predictors of Academic and Clinical Stress Among Nursing Students.

Nursing students experience significant academic and clinical stress due to challenging coursework, assessments, and educational demands, as well as the pressures associated with gaining practical healthcare experience. These challenges can lead to anxiety, fear of making errors, and concerns about patient well-being, ultimately impacting students' mental health and their preparation for a nursing career. assesses the predictors of academic and clinical stress among nursing students. A cross-sectional study design was used with a convenience sample of 113 nursing students. The study team conducted the study at the Faculty of Applied Medical Science, Nursing Department at Prince Sattam bin Abdulaziz University. The researchers used three instruments for data collection and asked all nurse students to complete the online questionnaires, which utilized perceived clinical settings and academic stress. The mean age of the studied nursing students was 21.2 years old. The study observed students had moderate perceived stress levels furthermore, the total levels of the academic stress domain's mean and standard deviation in students were 90.5 ± 32. Also, a significant relationship between perceived stress and clinical setting hours per week in nursing students, and hospital clinical setting type in nursing students. There was a correlation between academic stress and the ages of students. Students' academic stress was statistically significantly correlated with their educational level. Academic and clinical stress significantly impacts nursing students; the most common reasons that increase stress are fear of making mistakes and harming the patient. Accordingly, the study advocates for developing educational strategies and a structured course curriculum before student nurses are sent to clinical areas to enhance their capabilities and reduce academic and clinical stress.

Satisfaction of Undergraduate Nursing Students Regarding their Clinical Placement: A Focus Group Study

A crucial component of nursing students' education for providing high-quality and secure patient care is their clinical experience. Regarding this, it is crucial that student nurses are satisfied with their practical experiences. Student nurses' experiences in clinical placements can offer valuable insights for the development of successful nursing education programmed. Objective: To determine how satisfied undergraduate nursing students are with their clinical rotation. Methods: The study design used for the project was qualitative descriptive exploratory research. The sample size of the study was 30 BSN students of final year that were selected through purposive sampling technique, divided into 6 groups, where each group contain 5 students and attended semi-structure focus group interview using interview guide. The study setting was 2 nursing institutes of Peshawar i.e., post-graduate college of nursing, and institute of nursing sciences. Data were analyzed through content analysis, and the study was approved from ethical review board of institute of nursing sciences Khyber medical university Peshawar. Results: The data analysis identified four primary categories: theory to practical environment in the placement, poor clinical supervision, lack of orientation for clinical placement and inappropriate mentor-ship in clinical placement. Conclusions: To facilitate students’ clinical practice during their clinical hours, they must acquire pertinent knowledge, skills, and competency. The combination of theoretical and practical work is known as nursing practice, and theory without practice is seen as blind knowledge. In clinical settings, one cannot provide quality care if there is not a quiet and sound environment.

Perceptions and experiences of employers and mentors of graduate optometrists’ practice readiness in South Africa

Background. Optometry graduates are a key source of new recruits for private practice employers, the largest employer of South African (SA) optometry graduates. Universities should ensure that graduates are employable to compete in the labour market and to practise.Objective. To gain an understanding of the practice readiness of optometry graduates who qualified from SA institutions between 2016 and 2020, from the perspective of private practice employers and mentors (EMs).Methods. Using non-probability convenience sampling, private optometry EMs of recent graduates were invited to complete an online questionnaire designed around the core competencies for health professionals in SA. Quantitative data retrieved from a five-point Likert scale were analysed employing SPSS software, using the one-sample t-test, factor analysis and Cronbach’s alpha.Results. EMs (N=28) felt that graduates showed satisfactory competence in theoretical knowledge, communication, collaboration and professional skills, but weaknesses in aspects of clinical skills, leadership and management skills, and health-advocacy skills. The specific areas of weaknesses identified were dispensing skills, leadership, handling of criticism, handling of stress, implementing processes to improve services, industry awareness and practice management. All questions, except two questions for scholarly and professional skills, had an acceptable level of reliability.Conclusion. Practice readiness was viewed favourably by EMs for optometry graduates, but the specific weaknesses identified in the curriculum include stakeholder involvement from private employers. Increasing the diversity of clinical hours, including rotations in private practices, as well as facilitating and promoting work-based learning may strengthen practice readiness.

Defining the clinical and procedural opportunities available to residents during rural rotations.

Many emergency medicine (EM) residency programs include clinical rotations in rural emergency departments ("rural rotations") as part of their curriculum. These rotations are designed to expose residents to clinical scenarios that are less frequently encountered in tertiary centers. The objective of this study was to determine the rate at which residents were exposed to certain clinical and procedural experiences (CPEs) while on rural rotations compared to their usual academic training hospital. We conducted a retrospective chart review of all patient encounters involving EM residents at a large academic hospital in Rochester, Minnesota, compared with two rural hospitals in Austin, Minnesota, and Albert Lea, Minnesota, from July 1, 2019, to June 30, 2020. The frequency of each CPE was calculated and expressed as the number of CPEs encountered per 100 clinical hours worked. These values were compared between the rural and academic sites. A total of 33,417 patient encounters over a total of 41,700 resident clinical hours were analyzed between the three study sites. The two settings (rural vs. academic) had significant differences in baseline patient demographics including age, acuity, and admission rates. Several CPEs were found to occur at a higher frequency in the rural hospitals versus the academic hospital: ambulance necessity documentation (9.3/100 h rural vs. 0.07/100 h academic, p ≤ 0.0001), laceration repair (3.39/100 h rural vs. 2.0/100 h academic, p = 0.0004), and splint/cast application (1.53/100 h rural vs. 0.07/100 h academic, p ≤ 0.0001). Rural EM rotations provide residents exposure to a variety of valuable educational experiences. These rotations may provide residents with superior exposures to some clinical experiences compared to academic hospitals, particularly out-of-ED transfers and orthopedic procedures. Residency programs without a current rural rotation should consider creating this as an option for their trainees.

COVID-19 fear among junior undergraduate nursing students during the pandemic in South Africa.

During the COVID-19 pandemic, nursing students continued to work in facilities to complete clinical hours. Little was known about the impact of COVID-19 on nursing students during this time. To investigate fear of COVID-19 among junior undergraduate nursing students during the pandemic. A student nursing school at a university in the Western Cape, South Africa. A cross-sectional survey was conducted with 559 nursing students. A self-administered questionnaire with the validated COVID-19 fear scale (α= 0.84) was distributed. Scale reliability, factor analysis, means and 95% confidence intervals were calculated for items, overall scale and associations with demographic variables were tested using Kruskal-Wallis Independent Samples and Mann-Whitney U tests. There were 370 respondents (68.51% response rate), predominantly female (294, 79.5%) and exhibited a mean age of 21.9 years (± 3.9). More than half, 192 respondents (51.9%) reported mild fear of COVID-19, 103 (27.8%) moderate fear and 57 (15.4%) severe fear. Apart from gender, no significant demographic associations with overall COVID-19 fear were found. Factor analysis identified two distinct factors, physiological and emotional expressions of fear (moderate significant positive correlation between factors [r = 0.541]). The study's findings reveal that junior undergraduate nursing students, during the pandemic, generally reported experiencing mild fear related to COVID-19. This study contributes to the field of COVID-19 fear studies, provides insight into factors influencing fear levels and validates the scale's factor structure.

Perioperative Pain Management Simulation Course: Improving Anesthesia Trainees' Confidence in the Management of Perioperative Pain and the Associated Critical Incidents.

Introduction Pain management is a crucial aspect of patients' perioperative journey and a fundamental duty of every anesthetist. Throughout anesthesia training, there is an emphasis on the management of critical incidents, several of which surround pain management. With changes to the anesthesia curriculum over recent years, variable exposure to training opportunities, and a reduction in clinical hours during training, many trainees report feeling underprepared for their future roles as consultants. However, pain management remains a small fragment of the core anesthesia curriculum with no pain-focused simulation courses currently available across the UK.Simulation has proven to aid learning transfer in complicated and stressful scenarios with a substantial improvement in knowledge retention and prevention of skill loss while eliminating the risk of harm to patients. Aim A novel perioperative pain management simulation course was designed and implemented in the East of England to equip junioranesthesia traineeswith the knowledge, skills, and confidence to manage perioperative pain and the associated critical incidents. Methods A multidisciplinary team (MDT) was involved in the course design. The faculty consisted of anesthesia consultants, trainees, pain nurses, and simulation technicians. The course ran twice over a six-month period both locally and regionally. A blended learning approach was adopted where 17 trainees attended PowerPoint presentations providing an overview of basic pain theories, perioperativepain management, regional anesthesia, and labor analgesia. Trainees then underwent telecasted simulation training using replicated patient notes, imaging, blood gas analysis, and a high-fidelity SimMan®. A debriefing period followed each scenariousing Pendleton'smodel. An anonymized questionnaire was completed by all trainees before and after the course to assess improvement in theirknowledge and confidence levels across fourdomains covering the management of perioperative pain. Results All 17 trainees completed the questionnaire; therefore, the entire dataset was analyzed. The pre-course questionnaire showedthat usinga scale of zero to 10, the vast majority of trainees reported low levels of confidence (<6/10) in the management of chronic pain during the perioperative period (82%), intraoperative pain management (76%),regional anesthesia(88%), and labor analgesia (65%). Following thesimulation training, the results showed an overwhelmingly positive improvement in all 17 trainees' knowledge and confidence across all four tested domains. All 17 trainees (100%) also showed an improvement in their understanding of local pain protocols. The subjective feedback was positive, highlighting the overall usefulness of the course andthat thetailored complexity of each simulation scenario was appropriateto each candidate's prior level of experience. Trainees also reported feeling more confident in starting their anesthesia on-calls. Conclusion This novel simulation course is the first of its kind in pain management. It has shown great improvements in trainee confidence in managing perioperative pain and the associated critical incidents. Subjective feedback has also been positively reassuring. Its inclusion into the East of England anesthesia training programand national training curriculum would greatly enhance trainee's knowledge and experience in pain management in the perioperative setting.

"Anxiety, COVID, Burnout and Now Depression": a Qualitative Study of Primary Care Clinicians' Perceptions of Burnout.

Clinician burnout has become a major issue in the USA, contributing to increased mental health challenges and problems with quality of care, productivity, and retention. The objective of this study was to understand primary care clinicians' perspectives on burnout during the COVID-19 pandemic as well as their perspectives on the causes of burnout and strategies to improve clinician well-being. This qualitative research involved in-depth interviews with 27 primary care clinicians practicing in a range of settings across the USA. Semi-structured interviews lasted between 60 and 90 min and were conducted using Zoom video conferencing software between July 2021 and February 2023. Transcripts were analyzed in NVivo software using multiple cycles of coding. Clinicians shared their experiences with burnout and mental health challenges during the COVID-19 pandemic. Contributors to burnout included high levels of documentation, inefficiencies of electronic health record (EHR) systems, high patient volume, staffing shortages, and expectations for responding to patient emails and telephone calls. The majority of participants described the need to work after clinic hours to complete documentation. Many clinicians also discussed the need for health system leaders to make sincere efforts to enhance work-life balance and create a culture of health and well-being for health professionals. Suggested strategies to address these issues included supportive leadership, accessible mental health services, and additional administrative time to complete documentation. The results of this study provide an in-depth view of participating primary care clinicians' experiences and perceptions of burnout and other mental health challenges. These viewpoints can improve awareness of the issues and strategies to improve the health and well-being of our clinician workforce. Strategies include aligning payment models with the best approaches for delivering quality patient care, reducing administrative burden related to documentation, and redesigning EHR systems with a human factors approach.

Racial Disparity in Social Work Professional Licensure Exam Pass Rates: Examining Institutional Characteristics and State Licensure Policy as Predictors

ABSTRACT Purpose The Association of Social Work Boards (2022a) released a report evidencing test-taker demographics as the strongest predictor of professional licensure exam pass-rates. The purpose of this study was to examine statistical predictors of social work professional licensure exam pass rate disparities between first-time Black/African American and White test-takers. Materials and Methods The study addressed the following research question: To what extent do institutional and state licensure characteristics predict race-based disparities in social work licensure exam pass rates? To answer this question, the authors built a data set in an Excel spreadsheet comprised of institutional and state licensure variables using publicly available and reliable sources. Results States requiring more clinical supervision hours and imposing higher licensure fees tended to report higher overall pass rates on the ASWB exam. Additionally, a notable correlation was found between states with a higher proportion of Black/African American residents and increased pass rates. Conversely, states that had established a larger number of licensure tiers typically saw lower overall pass rates. Furthermore, it was noted that schools located in the Southern U.S. demonstrated significantly lower ASWB pass rates compared to schools in other regions of the country. Discussion Recommendations are made regarding future research efforts and professional licensure and regulation standards. Conclusion Pass rate disparities have implications for individual exam-takers and their families; for clients and constituencies; and for social work practice, research, ethics, and education.

Undergraduate Training in Psychiatry: Observational Perspective of Medical Officers Working at Primary Health-care Settings

Abstract Background: Primary care physicians are not adequately trained to tackle mental health problems. The study aimed to evaluate undergraduate training in Psychiatry: An observational perspective of medical officers. Materials and Methods: It was a cross-sectional study conducted in North India. Participants were assessed on a self-designed questionnaire developed by the Indian psychiatric society to assess various aspects of undergraduate training. Other questionnaires measured residents’ satisfaction with the quality of training programs and perceived need for psychiatric training in undergraduate courses. Results: The participant’s mean age was 32.4 years; majorities were male medical officers. About one-tenth reported that there were no separate psychiatry departments and designated psychiatry consultants in their college. Approximately 50% reported: No regular supervision by any psychiatric faculty or having psychiatric disorders discussions in clinical rounds. More than half (50.9%) were not confident enough to identify common signs and symptoms of psychiatric problems. From one-third to half of the participants were unsatisfied with various aspects of the training program, like teaching skills, diagnostic interviews, clinical posting, etc. Majority (77.3%–83.7%) agreed that there is a need to improve the psychiatry training program; during the clinic rounds, psychiatric diagnosis should be discussed, and psychiatry should be a separate subject in under-graduation. Conclusion: Primary health-care physicians were unsatisfied with an undergraduate psychiatry training program. Hence, psychiatry should be an independent subject during the undergraduate training program, with dedicated theoretical and clinical hours for psychiatry training and a separate paper for evaluation.

Standardization of Outpatient Care after CAR-T Therapy across a Large Cell Therapy Network- through Technology and Decentralized Virtual Nurses: Preliminary Results

Introduction: Shifting Chimeric Antigen Receptor T-cell (CAR-T) therapy to the outpatient setting may increase patient satisfaction and inpatient capacity, and reduce infection risk. Outpatient protocols require resources for patient management outside of clinic hours to be safe and effective. Our Transplant and Cellular Therapy Network (TCTN) leveraged wearable technology and decentralized nurses in four outpatient CAR-T programs. We sought to characterize patient adherence, time spent on patient monitoring, and clinical outcomes. Methods: Patients were deemed eligible for outpatient therapy if they were adults (18+ years), lived within 30-60 minutes of the treating hospital, had a 24/7 caregiver, and received CAR-T with known risks of developing cytokine release syndrome (CRS). The outpatient CAR-T program included enrollment into an FDA-cleared virtual care platform, daily engagement with virtual nurses for the duration of the program, and in-person clinic visits during the highest risk period (Days 1-14). The remote monitoring kit included a wearable device that continuously transmitted vital signs (pulse, respiratory rate, O 2 saturation and skin temperature), a tablet, axillary temperature patch and blood pressure (BP) cuff. Patients were asked to always wear the device outside of clinic visits, take a BP reading 3x/day, and complete surveys via the tablet. A multidisciplinary taskforce established clinical pathways for remote monitoring across sites and developed parameters for alarms, virtual nurse check-ins, and escalation of care to ER/clinic. Virtual nurses contacted patients based on vital sign trends, responded to patient concerns, and triaged in accordance with clinical pathways, escalating as appropriate. The virtual care platform, video and phone call logs with the virtual nurses, and clinical data were extracted for 40 patients between 2/20/23 and 6/15/2023. Inpatient admission, patient adherence, alarms, calls, and clinical metrics were summarized. Non-parametric measures were reported as median (IQR). Metrics for specific windows of time were reported for a subset of variables: wearable adherence (day vs. night) and alarms/calls during clinic hours (weekdays 8 am - 5 pm) vs. non- clinic hours. Adherence was derived from tasks/wear time completed vs. prescribed. Results: Forty patients (66 ± 12 years, 24 male) with diagnoses of Non-Hodgkin Lymphoma (75%), Plasma Cell Disorder (20%), or Acute Lymphoblastic Leukemia (5%) received CAR-T therapy [axi-cel (40%), liso-cel (25%), cilta-cel (20%), brexu-cel (12.5%), tisa-cel (2.5%)] and completed the outpatient CAR-T program. The median length of monitoring on the platform was 14.7 (10.4 - 27.6) days. Overall wearable adherence was 79 (67.7 - 87.9) %; 67 (48.7 - 83.4) % in the day and 89.1 (79.8 - 92.8) % at night. Median survey completion was 50 (7.7 - 80) % and BP compliance was 95 (69.8-100) %. Out of 717 patient days, 68.4% had 100% BP compliance (3 readings/day). There was a total of 780 alarms; 67% operational and 86% clinical alarms occurred during non-clinic hours (Table 1). The operational alarm rate was 0.5 and the clinical alarm rate was 0.6 per patient-day. 75% of patients triggered at least one operational and clinical alarm during their program. The virtual nurses engaged in 1102 calls through the tablet or phone (3.5 ± 3.4 mins). More than half of the calls were during non-clinic hours (63%) and 70% of calls were with a patient/care giver. Calls about a clinical alarm or clinical concern were 3x and 6.8x higher, respectively, during non-clinic hours. Twenty-seven patients required some level of hospital observation service and/or admission to the hospital; 25 patients developed CRS. Median duration from infusion to admission/observation was 5 (1-11) days. Median days to discharge was 5 (1-26). Of those admitted,10 patients were admitted to the ICU with a median stay of 5.5 (1-21) days. Conclusion: Our TCTN established a successful, integrated outpatient management process to ensure patient safety within the first 30 days post CAR T-Cell therapy. The virtual care platform and decentralized virtual nurses have enabled patients to recover safely with more time at home rather than in hospital. Future research will address patient and provider experiences and continue to expand on the safety and resource utilization of this integrated program.

Career Plans of US Physicians After the First 2 Years of the COVID-19 Pandemic

ObjectiveTo assess the career plans of US physicians at the end of 2021 relative to 2011 and 2014. MethodsPhysicians in the United States were surveyed from December 9, 2021, to January 24, 2022, using methods similar to prior studies in 2011 and 2014. Responding physicians in active practice (n=1884) were included in the analysis. At all time-points, physicians indicated the likelihood they would (1) reduce clinical work hours in the next 12 months and (2) leave their current practice within 24 months. ResultsIn 2021, 542 of 1344 (40.3%) indicated that it was “likely” or “definite” they would reduce clinical work hours in the next 12 months compared with 1120 of 6950 (16.1%) and 1275 of 6452 (19.8%) in 2011 and 2014. In 2021, 466 of 1817 (25.6%) indicated it was “likely” or “definite” they would leave their current practice in the next 24 months compared with 1284 of 6975 (18.4%) and 1726 of 6496 (26.6%) in 2011 and 2014. On multivariable analysis pooling responders from 2011, 2014, and 2021, physicians who responded in 2021 had higher odds of reporting intent to reduce clinical work hours compared with those who responded in 2014 (OR, 3.12; 95% CI, 2.73 to 3.57), whereas those responding in 2011 had lower odds relative to 2014 (OR, 0.81; 95% CI, 0.74 to 0.89). ConclusionRoughly two of every five US physicians intend to reduce their clinical work hours in the next year, more than double previous rates. These findings have potentially profound implications for the adequacy of a US physician workforce already facing substantial shortages.